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What are the substances that lead to Use Disorders?
What are the concepts of addictive use disorders?
What is the DSM-5 criteria/definition for/of addiction? How is it measured?
- The DSM-5 combines criteria for substance dependence and abuse
- it is measured on a continuum from mild to severe
- Definition: the continued use of any mind altering substance despite the negative consequences
- criteria: evidence of tolerance and withdrawal. taken in larger amounts over a longer time than intended.
- unsuccessful attempts to cut down
- great deal of time spent obtaining substance. Use continued despite knowledge of physical/ psychological problems
What Axis does addiction fall under? What is primary addiction? progressive? Chronic? When is it considered fatal?
- Axis 1
- primary: can be diagnosed alone; most often co-morbid with bipolar???????
- Progressive: different rates for different people
- Chronic: have the disease forever; addictive for entire life
- Fatal: when death is 15 years pre-mature
What are the common myths of addiction?
- "I only drink beer"
- "I don't drink that much in one setting?"
- I don't drink every day
- I have a good job, I can't be addicted
- I am a nurse
- I only smoke cigarettes
What does substance abuse mean? dependence?
- Abuse: use wrongfully or in a harmful way
- Dependence: compulsive/chronic requirement
What is the most prevalent substance of abuse? What is the most common drug taken to change how a person feels?
What percentage of people in the US will be involved in a MVA due to ETOH? What percentage of adult populations have been exposed to alcoholism in their families? How much more likely are children of alcoholics to develop alcoholism? How much high is the suicide rate?
- MVA due to ETOH: 65%
- exposed to alcoholism in families: 43%
- COA: 4x more likely to become alcoholic
- Suicide: 4x higher in alcoholics
What is the psychodynamic theory of addiction? Is there an addictive personality?
- Common factors: tolerance for frustration, pain are low. Self esteem and self regard are low.
- lack of success in life
- lack of meaningful relationships
- risk taking
*****What is dual-diagnosis? What population has the highest incidence of dual diagnosis?
An axis 1 diagnosis occurring with another axis 1 substance abuse disorder
how does the treatment differ for addiction? what is the average number of detoxs? How should addiction be viewed?
- It is rehabilitation not a cure
- average addict will have 6 detoxifications
- helpful to view addiction as chronic illness
What is the only substance where an objective measurement of intoxication exists?
What is the legal alcohol blood level? at what level will you see coma? At what level is death possible?
- .08% is the legal
- .40% is coma
- .50 and higher is death
What assessments can be used for addiction?
- family assessment
What are the types of rehabs?
- halfway houses
- other housing
- partial hospitalization
- intensive outpatient treatment
- outpatient treatment
What is the CAGE tool? What does it determine?
- Cut down:
- eye opener:
- 2 or more = an 85% prediction rate of addiction
What are the components of SBIRT?
- S: screening-use standardized screening tools
- B I: brief intervention- discuss the risks associated with use of substance
- RT:referral to treatment- suggest referral for a positive screen
What is Wernicke-Korsakoff syndrome? What are the manifestations?
- memory disorder caused by an inadequate intake of thiamine and a continuation of carbohydrate consumptions.
- Manifest.: amnesia, confabulation, attention deficit, disorientation, vision impairment
Describe alcohol withdrawal syndrome: When does it occur? How will the patient present? What can it progress to? What is the most important assessment question to ask clients?
- It occurs within 4-12 hours of reduction in heavy alcohol use.
- Manifestations: tremors, insomnia, agitation
- It can progress to withdrawal delirium
- The most important question to ask is *When was your last drink?
What is the CWIA measure?
the possibility of withdrawal. 6 sections 0 being no withdrawal
What is ativan dosing dependent on in withdrawal? What is given initially?
- on the CWIA score
- initially: thiamine 100 mg IV and once a day (po/iv/im), folate 1mg once a day, MVI once a day
- CWIA >8 OR moderate risk= Ativan 1-2mg V or 2-4mg PO x1 stat and Ativan 1mgIV or 2mg PO q4-6h standing
- Ativan 1 mg IV or 2mg PO q2h prn if: CWIA >8, HR> 100 or DBP >100
What is Delirium Tremors? What is the treatment?
- life threatening
- Tx: Benzos, IV Dilantin, Mag sulfate, Haldol, Thiamine, Beta-blockers
What percentage of nurses abuse substance and/or are chemically dependent?
20% and narcotic addiction is 30% higher than general public
What is the peer assistance program? when was it developed? What are the goals?
- Developed by the ANA in 1982 to help nurses with addiction
- Goals: have nurses recognize their impairment
- obtain necessary treatment
- regain accountability in their profession